Public Defender's Office says it alerted City Hall about flaws in the contract for pediatric ICUs The Public Defender's Office of the State of Maranhão (DPE-MA) says it alerted São Luís City Hall, even before hiring the company responsible for managing the pediatric ICUs at Hospital da Criança, about flaws in the bidding process that allowed for reduced teams and the work of doctors without specialization in pediatrics. ?Download the g1 app to see MA news in real time and for free According to Davi Veras, public defender at the Children and Adolescents Center, the irregularities highlighted may be related to the complaints made about the operation of the units' pediatric Intensive Care Units (ICUs). The bid was analyzed by the Public Defender's Office in July 2025 and identified inconsistencies between the notice and the preliminary technical study, a document that defines the structure necessary for the operation of the service. Among the problems highlighted were the reduction in the number of doctors and technical coordinators and the possibility of hiring professionals without specific training to work in pediatric intensive care. "We identified several non-conformities that deserved an alert, which is as if it were the harbinger of all this that we are experiencing. We identified there a bidding process that was contrary to a preliminary technical study, that is, the technical study is what will guide the entire contracting process, as the bidding contradicted the technical study, in relation to the sizing of teams, the specialization of these professionals who work in the ICU. So we warned several points of this contracting", reported the defender. Davi Veras, public defender at the Child and Adolescent Center Reproduction/TV Mirante Investigation of underreporting The public defender states that, in addition to the increase in deaths, the Public Defender's Office is also investigating signs of underreporting of cases. The analysis of medical records and other hospital documents, according to him, will be essential to verify whether all cases were properly registered and identify the extent of the irregularities. In an interview, the public defender challenged the comparison made by City Hall between mortality data from 2024 and 2025. According to him, the company only started operating in October 2025 and, therefore, the analysis must consider the current seasonal period, between March and August, when there are a greater number of child hospitalizations. “Complaints have been arriving, especially during this seasonal period, of greater intensity of children who fall ill more frequently, and we need to have an ICU with a technical team prepared to handle this case, so we need to discuss whether there is an increase in deaths, but discuss other technical issues, how long is the stay in that bed, what is the rotation of this ICU bed, in other words, these are all indicators that will tell us”, reinforced the defender. Headquarters of the Public Defender's Office of Maranhão (DPE-MA) in São Luís. Disclosure/DPE-MA The Public Defender's Office also investigates reports of alleged errors in assistance, such as inadequate administration of medications and care by professionals without specialization in pediatrics. According to Davi Veras, these cases still need to be individualized and confirmed through analysis of medical records, technical inspections and hearings from families. If proven, intervention in the unit is not ruled out, which may occur by court decision or by state or federal bodies. "We have trained teams because we have preliminary information that even medications were administered incorrectly to children and led to some children dying, inappropriate handling of children in critical situations because it was done by professionals who did not have the specialization and led to children dying. Now we need to identify and individualize these cases to individualize conduct (...) but we need to sort out this confusion, that is, an intervention in the hospital is not ruled out if this situation is not regularized", said the defender. MORE Brazilian Medical Services Institute (IBMED) admitted that it did not have enough staff to take on the service and tried to absorb the doctors who already worked at the hospital. "The company won the bid, but it did not have a ready team. The attempt was to hire doctors who already worked in the unit because it did not have enough professionals to start providing care," he said. Furthermore, he highlighted that the Children's Hospital stopped receiving resident doctors after the university hospital responsible for training suspended activities in the unit as it considered that there were not adequate conditions for teaching. "There are no more medical residents at the hospital, students and residents. Do you know why? Because the University Hospital identified that there were no conditions for these residents to learn at the Children's Hospital, so it was suspended. So we need to talk to the University Hospital to understand what the technical reasons were that led to the suspension of residents at the unit", concluded the defender. Hospital da Criança underwent audit Audit by the Ministry of Health at Hospital da Criança in São Luís lasts three hours and the final report should be released in the next few days Reproduction/TV Mirante Technicians from the Ministry of Health carried out, on Tuesday (14), an audit at Hospital da Criança Odorico Amaral de Matos, in São Luís, to investigate complaints related to the operation of the unit's pediatric Intensive Care Units (ICUs). The audit lasted around three hours and the final inspection report should be released in the next few days. According to Rafael Bruxellas, director of the National Audit Department of the Unified Health System (DenaSUS), the audit is not a routine visit, but an urgent action in light of complaints sent by parents of patients to the Ombudsman's Office of the Unified Health System (SUS). "The Ministry of Health came to Maranhão due to warnings from the population that they could not wait. DenaSUS is not here for a routine audit, but to investigate an urgent situation, in the face of a serious complaint about the risk to the lives of children in vulnerable health situations", said the director. According to Rafael Bruxellas, if irregularities are found, the report may contain warnings and recommendations for São Luís City Hall to present a contingency plan to correct the identified problems. In addition to in-person inspections, auditors must examine medical records, professional rosters, contracts, mortality indicators, hospitalization records and notifications posted in the SUS systems. Case is investigated by the Public Ministry The complaints investigated by the Ministry of Health are also investigated by the Public Ministry of Maranhão (MP-MA). According to the report, the Children's Hospital recorded 113 deaths in 2025 and of these, 101 would have occurred within the Health Unit's three ICUs. That would be 62 more deaths than in 2024. The City of São Luís disputes the numbers presented. According to the Municipality, in 2024, 112 deaths were recorded. However, 39 deaths are reported on the Ministry of Health website. The complaint points out that the increase in the number of deaths coincides with the change in management of the hospital's ICUs. According to documents cited in the investigation, more than half of the 31 deaths registered in the SUS system in 2025 could have been avoided. The classification and criteria used must be detailed by the responsible bodies during the investigations. Public Ministry of Maranhão investigates the increase in deaths in the children's ICUs at Hospital da Criança Reproduction/TV Mirante In October 2025, the City of São Luís placed a tender to hire the company Instituto Brasileiro de Serviços Médicos (IBMED) to manage the hospital's ICUs. The contract, according to the Public Ministry, would have drastically reduced resources to pay for the ICUs, as well as the number of doctors on the team. Professionals who previously worked at the unit say that some team members were invited to stay, but declined the proposal because they considered that the expected number of doctors would be insufficient to guarantee safe care. Company denies irregularities The Brazilian Institute of Medical Services (IBMED), a company contracted to manage the pediatric ICUs at Hospital da Criança, denies that it has reduced the number of professionals and states that there are no irregularities in the execution of the contract. According to the company's clinical director, Paulo Bayma, currently more than 20 doctors are part of the team responsible for care at the unit. "Today we have approximately 20 doctors. We brought professionals from various regions of Brazil who were willing to come here. Doctors came from Amazonas, Piauí, Ceará, São Paulo, from several states, so that pediatric medical care in our capital would not be interrupted", says the director. Families report delay in care and worsening of children Note from the City of São Luís angers families of victims Among the cases investigated is that of Kerliane, aged 7, who died after being treated and admitted to the Children's Hospital. According to her mother, civil firefighter Jainara Sousa dos Santos, the girl was taken to the unit on April 23 with pain in her leg. Two days earlier, she had suffered a fall in the backyard and injured her buttocks. Jainara states that her daughter underwent blood tests and a CT scan. After identifying a clot, the child was discharged without undergoing drainage. If there was a slight infection, they didn't say anything about it right away and discharged my daughter", reported Jainara. Kerliane, aged 7, died after being treated and admitted to the Children's Hospital in São Luís. Reproduction/TV Mirante Two days later, the mother returned to the hospital because the pain had increased and the girl began to vomit. New tests would have indicated an infection, in addition to changes in the lung, liver and kidneys. Kerliane was intubated in an area known as the “large room”, where she remained for two days before being transferred to an ICU. The girl died on April 29. The case is being investigated by the Maranhão Public Ministry. "My daughter's leg was just swelling and she (the doctor) said it was normal, that it was a reduction in fluid. When they thought about doing the drainage, it was on the 29th, my daughter passed away", lamented the mother. Professionals denounce reduction in medical staff MP investigates increase in deaths at Hospital da Criança, in São Luís Doctors, nurses and technicians who work or worked at Hospital da Criança say there was a significant reduction in staff after a change in ICU management. The professionals agreed to speak without being identified for fear of retaliation. According to a pediatrician, until October 12, 2025 the three ICUs had 53 doctors. The shifts would have eight professionals in the morning, six in the afternoon and six at night. From October 13th, according to reports, the number of doctors would have been reduced. In certain shifts, there would be only three professionals to serve the three ICUs — one doctor in each unit. And we're talking about people who have no experience in pediatrics. In the vast majority of cases, it is not a pediatrician who is on duty, and this has a direct impact on assistance." What do the authorities say? City Hall denies omission of data São Luís City Hall denied that there is a widespread shortage of supplies and medicines at the Children's Hospital. Municipal management admitted, however, that occasional reductions in stocks may occur during periods of high demand. In these situations, according to the municipality, internal relocation of materials or replacement of medicines with equivalent products is carried out. Regarding safety and quality of care, the city hall stated that it monitors pediatric ICUs to avoid interrupting services or closing beds. The municipal administration also highlighted the regional role of the Children's Hospital. According to the city hall, the unit provides around 10,000 consultations per month and 71% of patients admitted in the first half of this year came from municipalities in the interior of Maranhão. The City of São Luís also denied that it omits information from the Unified Health System and stated that all deaths registered in the hospital are officially reported to the Mortality Information System. According to municipal management, possible differences between local data and information available in federal public systems are caused by delays in processing and updating the national database. Contrary to what the complaint investigated by the Public Ministry points out, the city hall reported that there was no significant increase in the number of deaths at the Children's Hospital. According to the municipality, there was a variation of 4.5% between 2024 and 2025. The number of deaths increased from 112 to 117 in the period. The municipal management also stated that the ICU professional staff fully meets the requirements of the National Health Surveillance Agency, Anvisa. The city hall also reinforced that there are no official records of widespread shortages and that the supply of hospital materials follows continuous planning. Contract with IBMED Regarding the contracting of the Brazilian Institute of Medical Services, IBMED, the City of São Luís stated that the tender and the contract strictly comply with the legislation. The municipality also declared that the State Court of Auditors denied the requests for suspension of the contract and archived the representations presented against the municipal administration. Regional Council of Medicine The Regional Council of Medicine reported that it monitors the situation of the pediatric ICUs at Hospital da Criança. According to the agency, the objective is to guarantee the safety of care provided to patients and the working conditions of doctors. The council stated that it acts in accordance with the legislation and that it will take appropriate measures if irregularities are identified. Federal Public Ministry The Federal Public Ministry informed that it received the complaint about the situation at the Children's Hospital. The case will be analyzed by a public prosecutor, who will evaluate the adoption of the necessary measures to investigate the facts. Ministry of Health The Ministry of Health reported that it is already investigating the complaints sent to the SUS Ombudsman's Office about the deaths registered at the Hospital da Criança, in São Luís. A team from the National Audit Department of the Unified Health System, DenaSUS, was sent to the unit to analyze the situation in the pediatric ICUs and verify the information presented in the complaints.